document.write('<!--LP_FORM_START-->');
document.write('				<form');
document.write('					class="p-form__wrap"');
document.write('					method="post"');
document.write('					name="sfm-form"');
document.write('					id="sfm-form"');
document.write('					action="//ecosma-wimax.jp/area/confirm.html"');
document.write('				>');
document.write('					<table class="p-form__table">');
document.write('						<tbody class="p-form__tboby">');
document.write('							<tr class="p-form__row required-input">');
document.write('								<th class="p-form__label">');
document.write('									<span class="u-required">必須</span>');
document.write('									<span>郵便番号</span>');
document.write('								</th>');
document.write('								<td class="p-form__field">');
document.write('									<input');
document.write('										id="postcode1"');
document.write('										class="c-input"');
document.write('										type="text"');
document.write('										name="postcode1_s"');
document.write('										inputmode="numeric"');
document.write('										maxlength="7"');
document.write('										placeholder="例）1234567　※ハイフン不要"');
document.write('										autocomplete="postal-code"');
document.write('										value=""');
document.write('									>');
document.write('									<div class="ERR"></div>');
document.write('								</td>');
document.write('							</tr>');
document.write('							<tr class="p-form__row required-input">');
document.write('								<th class="p-form__label">');
document.write('									<span class="u-required">必須</span>');
document.write('									<span>お名前</span>');
document.write('								</th>');
document.write('								<td class="p-form__field">');
document.write('									<input');
document.write('										id="name"');
document.write('										class="c-input"');
document.write('										type="text"');
document.write('										name="name_s"');
document.write('										maxlength="50"');
document.write('										placeholder="例）エコスマタロウ"');
document.write('										autocomplete="name"');
document.write('										value=""');
document.write('									>');
document.write('									<div class="ERR"></div>');
document.write('								</td>');
document.write('							</tr>');
document.write('							<tr class="p-form__row required-input">');
document.write('								<th class="p-form__label">');
document.write('									<span class="u-required">必須</span>');
document.write('									<span>電話番号</span>');
document.write('								</th>');
document.write('								<td class="p-form__field">');
document.write('									<input');
document.write('										id="tel"');
document.write('										class="c-input"');
document.write('										type="tel"');
document.write('										name="tel_s"');
document.write('										maxlength="11"');
document.write('										placeholder="例）09012345678　※ハイフン不要"');
document.write('										autocomplete="tel"');
document.write('										value=""');
document.write('									>');
document.write('									<div class="ERR"></div>');
document.write('								</td>');
document.write('							</tr>');
document.write('						</tbody>');
document.write('					</table>');
document.write('					<!-- PC / スマホアクセスを判別（メール件名振り分け） -->');
document.write('					<input');
document.write('						type="hidden"');
document.write('						name="subject"');
document.write('						value="【ECW_G_SP_全国_夜間_wimax_個人_単体_None】提供メール"');
document.write('					>');
document.write('					<input');
document.write('						type="hidden"');
document.write('						name="orderid"');
document.write('						id="orderid"');
document.write('						value="250802-205403"');
document.write('					>');
document.write('					<input');
document.write('						type="hidden"');
document.write('						name="action"');
document.write('						value="conf"');
document.write('					>');
document.write('					<div class="p-form-button-wrap">');
document.write('						<input');
document.write('							id="btn_area_confirm"');
document.write('							class="p-form-button"');
document.write('							type="submit"');
document.write('							name="submit"');
document.write('							value="提供エリアを確認する"');
document.write('						>');
document.write('					</div>');
document.write('					<p class="p-form__note">※お問い合わせは、プライバシーポリシーを確認し、同意いただけたものとします。</p>');
document.write('				</form>');
document.write('				');
document.write('<script>');
document.write('var lpQuery = location.search;');
document.write('var element = document.forms[0]; ');
document.write('element.action = element.getAttribute(\'action\')+lpQuery;');
document.write('</script>');